Date post: | 13-Jul-2015 |
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PAIN MANAGEMENT
WITH FOCUS ON PRN
MEDICATION
ADMINISTRATION
Alexa Schroepfer, SCSU Senior Nursing Student H7000
Objectives:
Nursing staff will understand the importance of
offering PRN pain medications on a consistent
basis as show by evidence based practice
Nursing staff will be aware of the dynamics of
sedation scoring and nonverbal pain scale to
determine an effective pain medication regime
Nursing staff will be able to properly document
PRN medication administration and "schedule"
PRN pain medications in Excellian
H7000 HCAPS Survey Results
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
80.00%
85.00%
2013-11 2013-12 2014-01 2014-02 2014-03 2014-04 2014-05 2014-06
ANW HCAHPS Pain Management Top Box%
Staff did everything they could to help withpain
Pain Management Composite
Pain was well controlled
Use of Chronic Opioid Therapy in
Chronic Noncancer Pain
“Pain is defined by the International
Association for the Study of Pain (IASP) as “an
unpleasant sensory and emotional experience
associated with actual or potential tissue
damage or described in terms of damage”
“Chronic pain is defined by the IASP as “pain
that persists beyond normal tissue healing
time, which is assumed to be three months”
Evidence Review
APS-AAPM Clinical Guidelines for the Use of
Chronic Opioid Therapy in Chronic Noncancer
Pain
A key recommendation urges clinicians to
continuously assess patients on chronic opioid
therapy by monitoring pain intensity, level of
functioning and adherence to prescribed
treatments.
Breakthrough Pain: As-needed opioids can be
prescribed based on initial and ongoing analysis
of therapeutic benefit versus risk.
National Guideline Clearing
House
Pain management in older adults. In:
Evidence-based geriatric nursing protocols
for best practice.
Objective: To provide a standard of practice
protocol for pain management of older adults
such that they will either be pain free or their pain
will be controlled to a level that is acceptable to
the patient and allows the person to maintain the
highest level of functioning possible
Target Population: Hospitalized older adults
Guideline Continued
Interventions and Practices Considered
Assessment/Evaluation: Pain assessment at
regular intervals, review of medications, use
standardized measurement tools, assessment of
nonverbal and behavioral signs of pain, pt and
family reports
Management/Treatment: Individualized approach,
education about analgesic medications and
nonpharmacologic strategies, follow up
assessment-response and documentation
Major Recommendations
Older adults with cognitive impairment experience pain but are often unable to verbalize it.
Pain assessment must be regular, systematic, and documented in order to accurately evaluate treatment effectiveness.
Self-report is the gold standard for pain assessment.
Effective pain management requires an individualized approach.
Recommendations Cont.
Review medications, including current and
previously used prescription drugs, over-the-
counter drugs, and complementary therapies
(including home remedies). Determine
which pain control methods have previously
been effective for the patient.
Note: Documenting the next available time for
pain medications on the care boards
facilitations effective communication between
the nurse and patient/family.
Nursing Care Strategies
Develop a written pain treatment plan upon
admission to the hospital, or prior to surgery or
treatments. Help the patient to set
realistic pain treatment goals, and document
the goals and plan.
Educate patients to take medications
for pain on a regular basis and to avoid
allowing pain to escalate.
Treatment Guidelines
Administer pain drugs on a regular basis to maintain therapeutic levels. Use as needed (PRN) medications for breakthrough pain.
Document treatment plan to maintain consistency across shifts and with other care providers.
Older adults are at increased risk for adverse drug reactions due to age- and disease-related changes in pharmacokinetics and pharmacodynamics. Monitor medication effects closely to avoid overmedication or undermedication and to detect adverse effects. Assess hepatic and renal functioning.
Follow-up Assessment
Monitor treatment effects within one hour of
administration and at least every 4 hours.
Evaluate patient for pain relief and side effects
of treatment.
Document patient's response to treatment
effects.
Document treatment regimen in patient care
plan to facilitate consistent implementation.
Sedation
“Opioid-induced respiratory depression is a
concerning decrease in the effectiveness of an
individual's ventilatory function after opioid
administration (ASPMN, 2009).”
“The observation that increased sedation always
precedes respiratory depression indicates that
nurses can play a major role in preventing life-
threatening respiratory depression through
systematic sedation assessments that lead to
appropriate decision making during opioid
administration ”
Pain Assessment in Nonverbal
Patient
Establish a procedure for pain assessment
1. Attempt first to elicit a self-report from patient and explain why self-report cannot be used
2. Identify pathologic conditions or procedures that may cause pain
3. List patient behaviors that may indicate pain. Behavioral assessment scales may be used
4. Identify behaviors that caregivers and others knowledgeable about the patient think may indicate pain
5. Attempt an analgesic trial
“Scheduling” PRN medications
Remember to keep diligent about checking last
administration times!
ONLY “schedule” ahead ONE time.
This feature should only be used for individual
purposes not for other nursing staff.
Closure Statement
Continuous and thorough pain assessments
can help nurses determine individualized pain
management goals with patients. Proper
documentation and timely administration of
PRN pain medications can help to effectively
control pain.
References
Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., Ballantyne, J. C., Davies, P., & ... Miaskowski, C. (2009). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal Of Pain, 10(2), 113-130. doi:10.1016/j.jpain.2008.10.008
Herr, K., Coyne, P., Key, T., Manworren, R., McCaffery, M., Merkel, S., & ... Wild, L. (2006). Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44-52.
Nisbet, A., & Mooney-Cotter, F. (2009). Comparison of selected sedation scales for reporting opioid-induced sedation assessment. Pain Management Nursing, 10(3), 154-164. doi:10.1016/j.pmn.2009.03.001
U.S. Department of Health & Human Services: Agency for Healthcare Research and Quality. (2012). Pain management in older adults. In: Evidence-based geriatric nursing protocols for best practice. Retrieved from: http://www.guideline.gov/content.aspx?id=43932&search=prn+pain+management